Genitourinary Syndrome of Menopause

“The genitourinary syndrome of menopause (GSM)
includes bothersome vaginal, vulvar (lips of the vagina),
and urinary symptoms that can affect quality of life…”.1

Umbrella

What may the Genitourinary Syndrome of Menopause Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary/Genito-Urinary Syndrome of Menopause (GSM)
  • Menopause Vaginal Dryness
  • Urogenital Problems
  • Vaginal Atrophy
  • Vaginal Dryness
  • Vaginal Symptoms
  • Vulvovaginal Atrophy (VVA)

Definition

What is the genitourinary syndrome of menopause (GSM)?

DotS the definition of GSM may vary. On page one in Genitourinary Syndrome of Menopause, published May 2025, the (United States) Menopause Society’s (formerly the North American Menopause Society) definition is:

“The genitourinary syndrome of menopause (GSM) includes bothersome vaginal, vulvar (lips of the vagina), and urinary symptoms that can affect quality of life, sexual satisfaction, and even your relationship with your partner. Unlike hot flashes, which typically improve with time, GSM usually worsens over time without treatment”.2

Symptoms

What may be symptoms of GSM?

In Vaginal Atrophy: Symptoms & Causes – Symptoms the (United States) Mayo Clinic explain:

“Genitourinary syndrome of menopause symptoms can include:

  • Dryness, burning or itching in the vagina
  • Thin, watery, sticky, yellow or gray fluid that comes out of the vagina
  • Frequent or urgent need to urinate, or a burning feeling during urination
  • Losing control of the bladder, also called urinary incontinence
  • More-frequent infections of the urinary tract and vagina
  • Pain during sex due to less lubrication, or light bleeding after sex
  • Shortening and tightening of the vaginal canal”.3

Common or Not

How common is GSM?

In Symptoms of Menopause: Bladder, Vaginal and Vulval Problems the (Australian) Jean Hailes for Women’s Health (JH) explain:

“As you move into perimenopause and menopause, low oestrogen levels change your vulval, vaginal and bladder tissues. These changes may affect up to half of postmenopausal women”.4

  • “These symptoms are common- affecting between 40% and 90% of menopausal women. Urinary incontinence develops in up to 50% of postmenopausal women”.5

Cause

What causes GSM?

In Vaginal Atrophy: Symptoms & Causes – Causes the Mayo Clinic elaborate on:

“Genitourinary syndrome of menopause happens when the body makes less estrogen. Lower estrogen causes the tissues in the vagina to become thinner, drier, less elastic and more fragile”.6

Treatment

What are some GSM treatments?

On page one and two in Genitourinary Syndrome of Menopause the Menopause Society elaborate on:

“There are many effective treatment options for GSM, including over-the-counter and prescription therapies. Therapies for less severe symptoms include nonhormone over-the-counter lubricants used as needed for sexual activity and moisturizers used regularly (several times per week) to maintain moisture. Prescription therapies include low-dose vaginal estrogens, vaginal dehydroepiandrosterone inserts, and oral ospemifene. Nonhormone lubricants and moisturizers can be used in combination with prescription therapies for more severe symptoms.

  • “Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Hormone Therapy…
    • An effective and safe treatment, low-dose local estrogen applied directly to the vagina…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA may be options for women with a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.7

On page one in Genitourinary Syndrome of Menopause (GSM), reviewed November 2025, the British Menopause Society note:

“Whilst vaginal estrogen (also referred to as local estrogen) therapy is the best known treatment, newer drugs and interventions are now available”.8

Painful Intercourse

How may painful intercourse be resolved?

The Mayo Clinic explain:

“… make an appointment if you have painful sex that doesn’t get better after you use a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others), water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others) or silicone-based lubricant (ID Millennium, Pink, Pjur, others)”.9

Vaginal Estrogen

Can vaginal estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use, published February 2025, the Menopause Society explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina”.10

Prevention

How may GSM be prevented?

In Vaginal Atrophy: Symptoms & Causes – Prevention the Mayo Clinic elaborate on:

“Regular sexual activity, either with or without a partner, may help prevent genitourinary syndrome of menopause. Sexual activity increases blood flow to the vagina, which helps keep tissues in the vagina healthy”.11

Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)

What is the Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025), published April 2025, endorsed by The International Society for the Study of Women’s Sexual Health (ISSWSH) and The Menopause Society (TMS)?

In Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025) the authors elaborate on:

“This guideline provides information to clinicians regarding identification, diagnosis, counseling, and treatment for patients with GSM to optimize symptom control and quality of life while minimizing adverse events. The strategies defined in this document were derived from evidence-based and consensus-based processes; however, shared decision-making is the optimal strategy to individualize level of impact and ultimate interventions”.12

What is AUA, SUFU and AUGS?

In the context above, these abbreviations stand for the:

Health Care Provider

What if I think I have GSM?

If you think you have GSM it is important to talk to your health care provider. In The 2023 Practitioner’s Toolkit for Managing Menopause – Effectiveness: Local Treatment of Urogenital Atrophy, published online 01 December 2023, the authors note:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.13

In Symptoms of Menopause: Bladder, Vaginal and Vulval Problems – Urinary Symptoms the JH explain:

“While symptoms such as hot flushes usually disappear over time, bladder, vaginal and vulval problems can persist and may even get worse. But many treatments are available, so ask your doctor for recommendations”.14

Health Topics A-Z

Where may I find Health Topics A-Z related to Genitourinary Syndrome of Menopause?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. ACOG Explains: Managing Menopause Symptoms [American College of Obstetricians and Gynecologists]
  2. BMS TV: Urogenital Atrophy
  3. Bladder Control: Lifestyle Strategies Ease Problems
  4. Bladder Diary
  5. Bladder Diary
  6. Breast Cancer Survivors Find Relief for Debilitating Menopause Symptom
  7. CAMS Menopause Hour: Genitourinary Wellness In Women [Council of Affiliated Menopause Societies]
  8. Complementary Medicines and Therapies: Options for Menopausal Symptoms
  9. Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause: An Evidence Map
  10. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Preparing for Your Menopause Health Care Visit
  11. Deciding About Hormone Therapy Use
  12. Douching
  13. Estradiol (Vaginal Route)
  14. Experiencing Vaginal Dryness? Here’s What You Need To Know
  15. Experts Answer Your Menopause Questions In New Video
  16. FAQs: Vulvovaginal Health
  17. FDA Direct: Removing Black Box Warnings for HRT (Part 1/2)
  18. FDA Direct: Removing Black Box Warnings for HRT (Part 2/2)
  19. Find A Menopause Practitioner [United States and Other]
  20. Find A Practitioner [Australasian Menopause Society i.e. Australia and New Zealand]
  21. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  22. Gaslighting of Genitourinary Symptoms of the Menopause
  23. Genitourinary Syndrome of Menopause
  24. Genitourinary Syndrome of Menopause
  25. Genitourinary Syndrome of Menopause (GSM)
  26. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)
  27. HRT Questions Answered
  28. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review
  29. Hormone Therapy: Is It Right for You?
  30. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Common Questions About Vaginal Oestrogen
  31. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  32. Hormones and Urinary Symptoms In Women | Dr Louise Newson
  33. How To Talk To Your Doctor About Bladder Leakage
  34. How To Talk To Your Doctor About Menopause
  35. How To Talk To Your Doctor About Painful Sex
    Menopause Symptoms
  36. How Vaginal Hormones Can Transform the Health of Women
  37. International Menopause Society (IMS) Recommendations and Key Messages on Women’s Midlife Health and Menopause
  38. International Society for the Study of Women’s Sexual Health: Find A Provider
  39. Is It Too Late To Start HRT?
  40. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  41. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing, Intimacy and Menopause [+ Video: Menopause Is the End of Your Sex Life]
  42. Lubricant Alternatives: What To Use and What To Avoid
  43. Managing Menopause Symptoms [+ Video Courtesy: Mayo Clinic News Network]
  44. Mayo Clinic Minute: Menopause and Sexual Health [+ Video Courtesy: Mayo Clinic News Network]
  45. Mayo Clinic Q and A: Perimenopause Transitions and Concerns
  46. Menopause
  47. Menopause
    Black Women’s Menopause
  48. Menopause Checklist Podcast: Episode 1: A Wee Problem
  49. Menopause Checklist Podcast: Episode 6: Hello Lubricant!
  50. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Genitourinary Syndrome of Menopause
  51. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Symptom Tracker
    Genitourinary Syndrome of Menopause
  52. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  53. Menopause Ruining Your Sex Life?
  54. Menopause: Identification and Management [NICE Guideline Published: 12 November 2015 Last Updated: 07 November 2024]
    Genitourinary Syndrome of Menopause
  55. Menopause: Identification and Management: NICE Guideline [NG23] Published: 12 November 2015 Last Updated: 07 November 2024
  56. Navigating Menopause Together: How Partners Can Help
  57. Navigating Menopause: Honest Answers To All Your Questions [+ Video: What To Expect in Menopause]
  58. Navigating Menopause Care Resource Guide
  59. New AUA Guideline Offers Clinicians A Practical Toolbox for GSM Management [American Urological Association]
  60. Non-Hormonal Treatments Offer Relief for Genitourinary Syndrome of Menopause
  61. Painful Vaginal Sex (Dyspareunia)
  62. Pelvic Floor Health | Dr Louise Newson LIVE
  63. Perimenopause
    Genitourinary Syndrome of Menopause
  64. Perimenopause and Menopause Symptom Checklist
    Genitourinary Syndrome of Menopause
  65. Preventing Urinary Tract Infections After Menopause: What Every Woman Should Know
  66. Questions To Ask Your GP About Menopause
  67. Struggling With UTIs After Menopause? Experts Say This Can Make A Difference
  68. Surprising Menopause Symptoms Q&A | Dr Louise Newson
  69. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems
  70. The 2023 Practitioner’s Toolkit for Managing Menopause
  71. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  72. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause
  73. Therapeutic Choices for Genitourinary Syndrome of Menopause (GSM) In Breast Cancer Survivors: A Systematic Review and Update
  74. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  75. Treating Incontinence During Your Perimenopause and Menopause Years
  76. Treatments for Menopause
  77. UTI: This Common Infection Can Be Serious
  78. Urinary Incontinence In Women
  79. Urogenital Problems
  80. Use of OTC Products and Persistent Vulvovaginal Irritation In Postmenopausal Women, With Caroline Mitchell, MD, MPH
  81. Vaginal Atrophy
  82. Vaginal Atrophy
  83. Vaginal Dryness
  84. Vaginal Dryness
  85. Vaginal Dryness
  86. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  87. Vaginal Dryness: Alternative Treatments
  88. Vaginal Laser Therapy
    Genitourinary Syndrome of Menopause
  89. Videos & Podcasts: Videos – Genitourinary Syndrome of Menopause
  90. Videos & Podcasts: Videos – Menopause and Hormone Therapy: Current Perspectives and Controversies
  91. Vulval Irritation
  92. Webinars: The Burn, the Itch, the Pain, the Urge: GSM In Women
  93. What Is the Difference Between Vagifem and Estring?
  94. What Types of Vaginal Oestrogens Are There?
  95. Which Vaginal Moisturiser Should You Use?
  96. Why You Get An Itch or Thrush on Vaginal Estrogen and What To Do About It
  97. World Menopause Day 2024: Leaflet for Women – Menopause and Menopause Hormone Therapy [Multiply Languages]
  98. World Menopause Day 2024: Poster for Women – The 5 Ws of Menopause Hormone Therapy (MHT)

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Genitourinary Syndrome of Menopause. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 14 January 2026
  2. Genitourinary Syndrome of Menopause. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 14 January 2026
  3. Vaginal Atrophy: Symptoms & Causes – Symptoms. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 14 January 2026
  4. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems. Last Updated: 15 October 2025. Last Reviewed: 23 April 2025. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms/ Accessed: 14 January 2026
  5. Genitourinary Syndrome of Menopause: Key Points. 15 July 2024. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/genitourinary-syndrome-of-menopause
  6. Vaginal Atrophy: Symptoms & Causes – Causes. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 14 January 2026
  7. Genitourinary Syndrome of Menopause. 2025: 1-2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 14 January 2026
  8. Genitourinary Syndrome of Menopause (GSM). Reviewed November 2025:1. British Menopause Society https://thebms.org.uk/wp-content/uploads/2025/11/09-NEW-BMS-ConsensusStatement-Genitourinary-Syndrome-of-Menopause-GSM-NOV2025-B.pdf Accessed: 14 January 2026
  9. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 14 January 2026
  10. Deciding About Hormone Therapy Use. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/default-document-library/MenoNote-Deciding-About-HT-2025.pdf Accessed: 14 January 2026
  11. Vaginal Atrophy: Symptoms & Causes – Prevention. 20 December 2025. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 14 January 2026
  12. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025). April 2025. American Urological Association https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause Accessed: 14 January 2026
  13. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam12 September 2024, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: The 2023 Practitioner’s Toolkit for Managing the Menopause Supporting Notes – Effectiveness: Local Treatment of Urogenital Atrophy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 14 January 2026
  14. Symptoms of Menopause: Bladder, Vaginal and Vulval Problems – Urinary Symptoms. Last Updated: 15 October 2025. Last Reviewed: 23 April 2025. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/menopause-symptoms/ Accessed: 14 January 2026
Topic Last Updated: 14 January 2026 – Topic Last Reviewed: 14 January 2026

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